Mailing address (Please list the address where you would prefer to receive your copy of SFP's official journal, Contraception, should you be selected for membership. If you do not want a hard copy please check the “online only” check box below):

Address 1:

*

Address 2:

City:

*

State:

*

Region:

*

Country:

*

Zip:

*

Online only Contraception journal

Education (Please fill out all fields that apply.)

Undergraduate

Institution:

Location:

Dates:

Degree:

Graduate 1not applicable

Institution:

Location:

Dates:

Degree:

Graduate 2not applicable

Institution:

Location:

Dates:

Degree:

Medical schoolnot applicable

Institution:

Location:

Dates:

Degree:

Residency 1not applicable

Institution:

Location:

Dates:

Residency 2not applicable

Institution:

Location:

Dates:

(if more than 2 residency locations, please use an additional page)

Fellowshipnot applicable

Institution:

Location:

Dates:

Check here if you are currently enrolled in or completed a Fellowship in Family Planning.

Highest Degree:

Do you currently, or are you in training to, provide clinical care?
YesNo

Do you currently, or are you in training to, conduct research?YesNo

Criteria for Fellowship

Sponsor requirement
Applicants must be sponsored by two SFP Fellows in good standing. Junior Fellows may not serve as sponsors. SFP staff will verify sponsors before processing applications.

Name of Primary Sponsor: *

Name of Secondary Sponsor: *

Presentation requirement
In order to be eligible for Fellowship in the Society of Family Planning, applicants must have either 1) been listed as an author on at least one scientific abstract presented (oral or poster presentation) at an SFP Scientific Meeting; or 2) have authored 15 publications in family planning, to be submitted to the Membership Committee and the SFP board for review as to whether the scholarly work supports induction of the fellow.*

In what year were you listed as an author on a scientific abstract presented at an SFP Annual Meeting (Reproductive Health 2010 or later)? *

Title of abstract (poster or oral presentation):
*

Research/publication requirement
In order to be eligible for Fellowship in the Society of Family Planning, applicants must have either 1) published at least three original research articles relating to family planning in peer-reviewed journals and have been listed as the first author on at least two of these; or 2) have been first author on a minimum of two articles and one academic book chapter.

Please list your selected articles below using Medline format:

Article #1 (you must be first author on this article): *

Article #2 (you must be first author on this article): *

Article #3 (or book chapter, as first author): *

Background information

Please list your current research interests:

Primary:

Secondary:

1.

3.

2.

4.

What types of studies interest you? (mark all that apply)

Qualitative

Clinical trials

Basic science

Survey studies

Meta analysis

Decision analysis

Other (please specify)

What is your primary field of professional expertise or academic focus?

Family medicine

Nursing

Social science

Midwifery

Obstetrics & gynecology

Internal medicine

Public health

Adolescent medicine

Other (please specify)

Countries you work in:

What are the primary reasons you would like to become a member of the SFP?

Professional development

Networking/community

Research funding opportunities

Educational opportunities

Encouraged by Fellowship Program

Other (please specify)

How did you hear about the Society of Family Planning?

*Demographics

Which category best describes your gender identity?*

Are you of Hispanic, Latino, or Spanish origin? *

Which category best describes your race?*

* Will not be visible to the public

Do you have a colleague who you feel should be encouraged to apply for membership in the Society of Family Planning? If so, please provide:

Name:

Institution:

Email address:

Please attach your current curriculum vitae:*

*From 2005 through 2010, SFP Scientific Meetings were held annually at the Reproductive Health conference. However, as of 2011, SFP’s annual scientific meeting is held in conjunction with the annual North American Forum on Family Planning, produced by SFP and Planned Parenthood Federation of America.